interprofessional communication

1. Inter-professional Practice in Health Care
Jennifer Illes, DC, MS

2. What is an interprofessional team?
• People from several professions
• Each trained to use different tools and
concepts
• Whose labor organized around a common
problem
• With continuous communication and frequent
reflection on both the groups work and its
process
• Usually with group responsibility for the final
product

3. BENEFITS OF
INTERPROFESSIONAL WORKING
• The way in which healthcare is delivered has become
increasingly dependent on team and interagency
working and it is reassuring that evidence suggests that
interprofessional teamworking does improve
patient/client outcomes. (Borrill et al. 2001)
In a study of healthcare teams, concluded that there is a
significant and negative relationship between the
percentage of staff working in Interprofessional teams and
patient mortality.

4. Taking Care of the Elderly
• As people get older, the likelihood of developing multiple and longer-
term needs increases.
• An ageing population in many western countries means that the
need for collaboration between professionals will become
increasingly important.
• Healthcare professionals must therefore develop the knowledge and
skills required to collaborate effectively at an interagency and
interprofessional level.

5. Not Just in Health Care
• Collaboration can occur between different professionals
within one organization or increasingly between
professionals who belong to a range of organizations
from the public, private and third sectors.
• Collaboration is not necessarily only required between
health workers. Social workers, police, lawyers,
teachers, probation officers and charity workers, for
example, are also part of the wider interprofessional
team involved in the support of an older persons needs.

6. Interest in Teamwork Ebbs and Flows (Ryan 1996)
From moral
treatment to
mental
hospitals
The medical
model and the
orthopsychiatric
trinity
The Trinity
won the
right to treat
Sociotherapy
and
broadening of
the mental
health team
Community
Mental Health
and
sociotherapy’
s democracy
Hospitals
emptied and
community
mental health
funding dwindled
DRG’s
managed care
and mental
health
fragmentation
Integrated
care and
inter-team
collaboration
# of
Articles
Decades
Patient safety is
linked to the
quality of
collaboration
5
6
16
23
8
5
11
50
0
5
10
15
20
25+
30s 40s 50s 60s 70s 80s 90s 00s
Estimate
2000-2010
Teamwork Articles in the Journal of Orthopsychiatry by Decade
Since the Journal Began in 1930

7. Chronic Disease and Frailty
Patient Safety
Success of Quality Improvement
The Quality of Working Life
Local Health Integration Networks
Primary Care and Family Health Teams
Why Interprofessional Practice? Why Now?

8. Province-Wide investment in Inter-Professional Education
Inter-professional Mentoring
Inter-professional Coaching
Inter-professional Preceptorships
Inter-professional prevention of delirium in the ED
Impact inter-professional practice within primary care groups
Inter-Professional Practice and Hospital/LTC accreditation
The Journal of Inter-Professional Care
GiiC – the geriatrics, inter-professional practice & inter-organizational
collaboration initiative for family health teams and community health
centers
Current Initiatives in Interprofessional Care

9. Barriers to interprofessional teamwork: practice
based issues
• There is a lack of preparation for interdisciplinary hostility . . . If
the practice of this specialized form of aggression is to be placed
on a higher level, at least as high as professional wrestling…the
subtle arts of patronage, insult and innuendo must be taught.
• Unrealistic expectations, lack of knowledge and perceived threats
to autonomy Fried & Leatt, 1986
• Professional jealousies and role boundary issues Strasser et al 1994
• We practice together but we train apart

10. Barriers to teamwork: professions think differently (from
Qualls and Czirr, 1988)
Logic of assessment: from ruling out to ruling in
Focus of efforts: from acute episodes to quality of life
Locus of Responsibility: from executive to collaborative
Pace of Action
Focus of attention: from task to process
Interprofessional stereotypes
Decision making expectations: from executive to consensus
Beliefs about professional independence: from autonomy to
interdependence

11. Barriers to teamwork: Though we practice together until recently we
trained apart (from Cleary & Howell, 2003)

12. History of Teamwork in Health Care
The Original Team - Romantic Era (circa 1900)
General Practitioner

13. History of Teamwork in Health Care
Classic Sequential Teamwork and the Specialist Era
(circa 1920)
Specialist Specialist
Nurse Nurse

14. History of Teamwork in Health Care
Sequential Multi-Professional Practice Teams
(circa 1930)
Specialist
Nurse
Psychology
Social
Work
Rehab

15. History of Teamwork in Health Care
Dynamic Multi-Professional Team (circa 1960)
from a cadre of professionals
Physician
Nutrition
Psychology
Physio
Nurse Social Work
Chiro
OT
Pharmacy
Dentist Recreation

16. History of Teamwork in Health Care
Dynamic Multi-Professional Team (circa 1960)
a team is convened around the needs of a particular patient
Physician
Social Work
Nurse
Psychology
OT
SLP

17. History of Teamwork in Health Care
Dynamic Inter-Professional Team (circa 1985)
from a cadre of professionals
Physician
Nutrition
Psychology
Physio
Nurse Social Work
SLP
OT
Pharmacy
Dentist Recreation

18. History of Teamwork in Health Care
Dynamic Inter-Professional Team (circa 1985)
A team is convened around the needs of a particular
patient
Core skills
Core skills
Core Skills
Core skills
Social Work
Physician
Pharmacy
Nurse

19. Multiprofessional Interprofessional
• Independent practice
• Guided by professional
standards
• Professions report to
depts.
• Leadership by rank or
profession
• Rigid role boundaries
• Conflict attributed to
individuals
• Little attention to team
process
• Interdependent practice
• guided by professional &
team standards
• Discussion &
collaboration
• Leadership by skill or
primary issue
• Flexible role boundaries
• Conflict is a team
responsibility
• Routine attention to team
process issues

20. Myths about Teamwork
• There are no leaders on teams; everyone is equal
• If we just work together, we will eventually become a
high performance team
• Everyone is accountable for everything on teams
• Teams take a long time to get up and running
• All team decisions must be made by consensus
• Conflict must be worked out for a team to be productive
• On the best teams, everyone likes everyone else
• The most important work takes place in team meetings
• Confrontation means conflict

21. Just putting people together to work in teams doesn’t
necessarily produce effective interprofessional teamwork

23. • CASE REPORT: CHIRO AND SURGEON